Overview of carpal fractures
- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
The carpals are the bones of the wrist between the radius and ulna proximally, and the metacarpals distally. These eight bones are collectively termed the carpus and are commonly divided into the proximal carpal row—scaphoid, lunate, triquetrum, and pisiform—and the distal row—trapezium, trapezoid, capitate and hamate. In general, carpal fractures occur from either direct or indirect trauma.
This topic provides an overview of basic carpal anatomy, mechanisms of injury, general principals of examination and imaging, and the initial care of adults with carpal fractures. More detailed discussions of common and important wrist injuries are presented separately. (See "Evaluation of the adult with subacute or chronic wrist pain" and "Evaluation of the adult with acute wrist pain" and "Distal radius fractures in adults" and "Scaphoid fractures" and "Triquetrum fractures" and "Lunate fractures and perilunate injuries" and "Capitate fractures" and "Hamate fractures".)
EPIDEMIOLOGY— Hand fractures are among the most common of extremity injuries, accounting for about 18 percent of all fractures. Carpal fractures comprise upwards of 8 percent of hand fractures [1-3]. Scaphoid fractures are by far the most common of the carpal fractures, and account for 10 percent of all hand fractures and 60 to 70 percent of all carpal fractures [4,5]. The triquetrum is the second most common carpal fracture, comprising between 13 and 28 percent. Fractures of the trapezium, hamate, capitate and trapezoid follow in prevalence, ranging from 2 to 4 percent of carpal fractures. The pisiform is the rarest carpal fracture at 0.5 to 1 percent [1,6-8].
CLASSIFICATION AND CLINICAL PRESENTATION
Carpal fractures are classified primarily by the anatomic location of the fracture (see 'Clinical anatomy' below) and secondarily based upon the features of the injury, including associated displacement, dislocation, and the number of fragments produced by the fracture (comminuted versus noncomminuted).
It is important to note that a significant proportion of carpal fractures involve multiple carpal bones, so if one carpal is fractured, the clinician should search for others.
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- CLASSIFICATION AND CLINICAL PRESENTATION
- Brief description of fractures
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- Axial loading
- Wrist hyperextension
- Wrist hyperflexion
- Deviation, traction, or rotation
- Direct blow to the palmar surface
- Combinations of forces
- SYMPTOMS AND EXAMINATION FINDINGS
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS